Cost-effectiveness and budget impact analysis of viscosupplementation with hylan G-F 20 for knee and hip osteoarthritis

Purpose: To estimate the cost-effectiveness and budget impact of viscosupplementation with one intra-articular (IA) injection of 6 mL hylan G-F 20 (Synvisc-One (R)) and with three injections of 2 mL hylan G-F 20 (Synvisc (R) 3x2) in knee osteoarthritis (OA) patients compared with conventional support therapy (CST - eg, NSAIDs and acetaminophen) and the cost-effectiveness of one IA injection of 2 mL hylan G-F 20 (Synvisc (R) 1x2) in hip OA patients compared with CST from an Italian Health System perspective. Methods: The model used was a Markov model with states for stages II-IV on the Kellgren-Lawrence scale and runs on 6-month cycles over a 5-year time horizon. A 3.5% discount was applied to both costs and utilities. Direct costs were determined from the perspective of the Italian National Health Service. A one-way and probabilistic sensitivity analysis was conducted for both comparisons. Results: Hylan G-F 20 1x6 mL and hylan G-F 20 3x2 mL for knee OA were very likely to be cost-effective when compared to acetaminophen (ICER = (sic)3,160.61 and (sic)3,845.81 per QALY, respectively) and NSAIDs as both ICERs are below (sic)25,000. The hip OA treatment by hylan G-F 20 1x2 mL was dominant compared to NSAIDs and very likely compared to acetaminophen. The results of the cost-effectiveness analysis were confirmed by one-way sensitivity analysis. The budget impact analysis for knee and hip OA showed a small increase in expenditure during 5 years. Conclusions: Hylan G-F 20 1x6 mL/hylan G-F 20 is a cost-effectiveness treatment compared to NSAIDs and acetaminophen in the treatment of knee/hip OA in Italy. The treatment of hip and knee OA resulted in cost-saving with hylan G-F 20 1x2 mL and economically sustainable with hylan G-F 20 1x6 mL. However, Real Word Evidence studies should be conducted in order to estimate costs associated with both prosthetics and to understand the reduction of physiotherapy and medication due to hylan G-F 20.